I have hit on a way to present hand expression in a way that's
"acceptable" in a highly tech oriented society.  When I talk with
moms about what to expect the first few days, one topic of course is
fullness (or engorgement depending on your definition) when the milk
volume "kicks in".

"Some moms will find that the breast is so full/firm that baby has
difficulty latching and compressing the breast.  In these cases it
is often helpful to remove just enough milk to soften the breast for
baby.  The amount that needs to be removed varies widely from mom to
mom and from baby to baby.  Often a half teaspoon or so in enough,
while I have seen a rare mom that needs to remove an ounce before
baby can latch and nurse effectively.  Hand expression allows mom to
feel when the breast has softened, while with a pump she would need
to stop from time to time and check if the breast has softened.
Some moms find they get so good at this that they never use a pump
even later (pumping for work or whatever) while other moms may use
hand expression to start the flow and then switch to whatever pump
is working for her."

I find that moms are very accepting of this "temporary" superiority
of hand expression when they might be resistant to the process if
presented as the ideal for any need to express milk.  And there are
those who go on to use it exclusively, especially "at home" moms who
may only need to express on an occasional basis.  Of course, the
recent blackout was an opportunity to extol the virtues of being
able to hand express on those occasions when electric power may be
temporarily interrupted.  Even those not affected by such hugh
outages can still be subject to outages due to storms, accidents
knocking down power lines, etc.

Winnie

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